This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

Main Points

• Data are published on consultant-led Referral to Treatment (RTT) waiting times for patients who were treated during July 2011. In total, 302,285 admitted patients and 853,420 non-admitted patients, for whom English commissioners are responsible, completed their RTT pathway during July 2011.

• At national level, 90.6% of admitted patients (measured on an adjusted basis) and 97.4% of non-admitted patients completed their RTT pathway within a maximum of 18 weeks.

• The 95th percentile time waited for patients completing an RTT pathway in July 2011 was 22.4 weeks for admitted patients and 15.8 weeks for non-admitted patients. (See Statistical Note number 6)

• The average (median) time waited for patients completing an RTT pathway in July 2011 was 8.2 weeks for admitted patients and 3.9 weeks for non-admitted patients.

• For patients still waiting for treatment (incomplete pathways) at the end of June 2011, the median waiting time was 5.8 weeks and the 95th percentile was 23.8 weeks.

• Tables 1 and 2 show average (median) waiting times, 95th percentile waiting times and the percentage of patients whose RTT pathway was completed within 18 weeks by treatment function. Table 3 shows RTT waiting time trends from March 2007 to July 2011 for completed and incomplete pathways.

For admitted patients, adjusted data (allowing for legitimate pauses of the RTT clock) is used to measure waiting times.
Statistical Notes

1. National Statistics

The United Kingdom Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Official Statistics. Designation can be broadly interpreted to mean that the statistics:
• meet identified user needs;
• are well explained and readily accessible;
• are produced according to sound methods, and
• are managed impartially and objectively in the public interest.

Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed.

“Clock Stops”

The following activities end the Referral to Treatment (RTT) period and lead to the RTT clock being stopped:
- first treatment - the start of the first treatment that is intended to manage a patient’s disease, condition or injury in a RTT period
- start of active monitoring initiated by the patient
- start of active monitoring initiated by the care professional
- decision not to treat - decision not to treat made or no further contact required
- patient declined offered treatment
- patient died before treatment

Referral to Treatment (RTT) waiting times

RTT data is collected from NHS providers (NHS Trusts and other providers) and signed off by commissioners (Primary Care Trusts).

The RTT data measures referral to treatment (RTT) waiting times in weeks, split by treatment function. The length of the RTT period is reported for patients whose RTT clock stopped during the month.

The Department of Health published the RTT Rules Suite on 28 November 2007. These documents were updated in June 2010 and can be found on the Department of Health website.

The rules for the data collection are based on those set out in the rules documents.
The data collection is in three parts:
Part 1a - Completed pathways - admitted
Part 1b - Completed pathways - non-admitted
Part 2 - Incomplete pathways

The return includes all patients whose RTT clock stopped at any point in the reporting period. A column has been provided to enter data for patients whose length of RTT period is unknown, i.e. patients who have had a clock stop during the month but where the clock start date is not known.

For non-admitted patients, the RTT time is measured on an unadjusted basis - from the date the RTT clock starts to the date that the RTT clock stops, as detailed in DSCN 17/2006. For admitted patients, the RTT time is measured on an adjusted basis - from the date the RTT clock starts to the date that the RTT clock stops, allowing for legitimate pauses as described in the above RTT Rules Suite.

Incomplete pathways represent those patients who have been referred on to consultant-led referral to treatment pathways, but whose treatment had not yet started at the end of the reporting period. These patients will be at various stages of their pathway, for example, waiting for diagnostics, an appointment with a consultant, or for admission for a procedure.

Data Availability

Data for admitted patients (patients whose RTT clock stopped with an inpatient/ day case admission) has been published each month since January 2007 on an unadjusted basis.

Data for admitted patients (patients whose RTT clock stopped with an inpatient/ day case admission) has been published each month since March 2008 on an adjusted basis.

Data for non-admitted patients (patients whose RTT clock stopped during the month for reasons other than an inpatient/day case admission) and incomplete RTT times for patients whose RTT clock is still running has been published each month since August 2007.

Provider and Commissioner based data

Commissioner based returns reflect data on a responsible population basis, which is defined as:
• all those patients resident within the PCT boundary; plus
• all patients registered with GPs who are members of the PCT, but are resident in another PCT; minus
• All patients resident in the PCT, but registered with a GP who is a member of another PCT

Provider based returns cover patients for whom English commissioners are responsible.

Average (median) and 95th percentile waiting times

The median is the mid-point of the waiting times distribution (i.e. the 50th percentile) and can be interpreted by saying that 50% of all patients, whose RTT clock stopped during the month, were treated within this time.

The 95th percentile is another statistical measure of the waiting time distribution. It can be interpreted by saying that 95% of patients, whose clock stopped during the month, were treated within this time with one in twenty patients waiting longer than this time for treatment.

It should be noted that medians and percentiles times are calculated from aggregate data, rather than patient level data, and therefore are only estimates of the position on average waits.

Interpretation of RTT waiting times

Care should be taken when making month on month comparisons of these figures. Measures of waiting time performance are subject to seasonality. For example, the presence of bank holidays or the number of weekends in a calendar month both affect the number of working days. Similarly, adverse weather may result in emergency pressure and impacts upon the health service’s ability to preserve elective capacity. These factors can affect waiting times and should be considered when making comparisons across time.

Feedback welcomed

The NHS Operating Framework for 2011/12 published on 15 December 2010 states, ‘patients’ rights to access services within maximum waiting times under the NHS Constitution will continue and commissioners should ensure that performance does not deteriorate and where possible improves during 2011/12. With that in mind, providers should be expected to offer maximum waiting times to patients and there will be monitoring of compliance with this and the 95th percentile of waiting time. The median wait will also continue to be monitored with a view to improvement’.

The percentage of patients treated within 18 weeks will continue to be published as it is still of interest to NHS organisations, patients and the public.

We welcome feedback on the content and presentation of RTT statistics within this Statistical Press Notice and those published on the DH website. If anyone has any comments on this, or any other issues regarding RTT data and statistics, then please email RTTdata@dh.gsi.gov.uk
Additional Information

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